Inadequacy of diagnosis related group (DRG) reimbursements for limb salvage lower extremity arterial reconstructions

Abstract

Prospective cost and reimbursement data were collected from 10 centers in various parts of the United States on 566 patients undergoing lower extremity arterial reconstructions for limb salvage and nonlimb salvage indications. Information for each patient was available on indication and type of procedure, length of stay, the type of hospital insurance, and hospital costs/charges. Diagnosis related group payments from each center were used to determine net gain or loss for each patient. Patients were classified as having claudication or critical ischemia (limb salvage). Reimbursements matched costs/charges for the claudication group; overall mean loss in this group was only $915 per patient. However, all centers had important losses in the limb salvage group. Reimbursements averaged 60% of costs/charges, with a mean loss of $8158 per patient and an overall loss for all 10 centers of $3,653,918. An effort to remedy this inequity is progressing via a dialogue between representatives of the Society for Vascular Surgery, the North American Chapter of the International Society for Cardiovascular Surgery, and the federal government.

Lower extremity arterial reconstruction in the very elderly: Successful outcome preserves not only the limb but also residential status and ambulatory function

“…The collision of demographics with health policy is problematic because previous studies have shown that treatment of these problems is expensive 3,10,13 and becomes more so with older patients, 3 and the current levels of reimbursement for the treatment of vascular surgical patients, based on global payment schemes such as diagnosis-related groups, are inadequate to cover costs. [13][14][15] The effort to control health care costs has led to a closer scrutiny of all medical interventions. Part of the mandate of health care reform has been to provide care that is not only therapeutically effective but also cost effective.…”

Endovascular in Situ Bypass Decreases Morbidity and Hospital Stay following Infrainguinal Arterial Reconstruction

“…Protracted hospitalization following infrainguinal reconstruction accounts for most health-care dollars spent on these patients. 9 As experience is gained with EISVB, 1-to 2day hospitalizations will be feasible, which will translate into enormous health-care savings. Although cost-effectiveness of EISVB was not assessed in this study, Piano et al 10 looked at their early experience with the EISVB technique and found a modest reduction in LOS compared to conventional open ISVB, which lowered hospital costs from $27,000 to $18,000.…”

Inflation-Adjusted Medicare Reimbursement for Revision Hip Arthroplasty

“…Given that inadequate reimbursement may discourage providers from performing rTHA-I, failure to adequately account for these technically and financially demanding procedures may create barriers to access by patients with PJI. Specifically, the complexity of most rTHA-I procedures, the required resource utilization, and the associated increase in the lengths of hospital stays may delay access to definitive care, as poor reimbursement may lead challenging cases to be deemed undesirable at both the individual surgeon and the institutional level [24][25][26][27][28] . The goal of the present study, therefore, was to investigate temporal reimbursement trends for rTHA-I procedures in relation to those for rTHA-A procedures.…”